Efficacy of surgical management for esophageal squamous cell carcinoma in pathological stage T1b_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Duojie , WANG Cheng , WEI Xiaoping , YANG Jianbao , MENG Yuqi , SONG Tieniu , ZHANG Shaobo , FENG Haiming , JING Tao , JIANG Peng ,  LI Bin

Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, P.R.China;

Corresponding author：

LI Bin, Email: dr.leebin@outlook.com

Keywords：

Esophageal squamous cell cancer; pathological stage T1b; esophagectomy; long-term survival; surgery

DOI：

10.7507/1007-4848.202004051

Video：

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Objective To investigate the prognostic survival status and influence factors for surgical treatment of esophageal squamous cell carcinoma (ESCC) in pathological stage T1b (pT1b).Methods The patients with ESCC in pT1b undergoing Ivor-Lewis or McKeown esophagectomy in Lanzhou University Second Hospital from 2012 to 2015 were collected, including 78 males (78.3%) and 17 females (21.7%) with an average age of 61.4±7.4 years.Results The most common postoperative complications were pneumonia (15.8%), anastomotic leakage (12.6%) and arrhythmia (8.4%). Ninety-three (97.9%) patients underwent R0 resection, with an average number of lymph node dissections of 14.4±5.6. The rate of lymph node metastasis was 22.1%, and the incidence of lymph vessel invasion was 13.7%. The median follow-up time was 60.4 months, during which 25 patients died and 27 patients relapsed. The overall survival rate at 3 years was 86.3%, and at 5 years was 72.7%. Multivariate Cox regression analysis showed that lymph node metastasis (P=0.012, HR=2.60, 95%CI 1.23-5.50) and lympovascular invasion (P=0.014, HR=2.73, 95%CI 1.22-6.09) were independent risk factors for overall survival of pT1b ESCC.Conclusion Esophagectomy via right chest approach combined with two-fields lymphadenectomy is safe and feasible for patients with pT1b ESCC. The progress of pT1b ESCC with lymph node metastasis or lymphovascular invasion is relatively poor.

Citation： ZHU Duojie, WANG Cheng, WEI Xiaoping, YANG Jianbao, MENG Yuqi, SONG Tieniu, ZHANG Shaobo, FENG Haiming, JING Tao, JIANG Peng, LI Bin. Efficacy of surgical management for esophageal squamous cell carcinoma in pathological stage T1b. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 696-700. doi: 10.7507/1007-4848.202004051 Copy

1.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, Mar-Apr 2016, 66(2): 115-132.
2.	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3.	Merkow RP, Bilimoria KY, Keswani RN, et al. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst, 2014, 106(7): dju133.
4.	Nentwich MF, von Loga K, Reeh M, et al. Depth of submucosal tumor infiltration and its relevance in lymphatic metastasis formation for T1b squamous cell and adenocarcinomas of the esophagus. J Gastrointest Surg, 2014, 18(2): 242-249.
5.	Akutsu Y, Uesato M, Shuto K, et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: A retrospective analysis of 295 patients. Ann Surg, 2013, 257(6): 1032-1038.
6.	Lee L, Ronellenfitsch U, Hofstetter WL, et al. Predicting lymph node metastases in early esophageal adenocarcinoma using a simple scoring system. J Am Coll Surg, 2013, 217(2): 191-199.
7.	Gertler R, Stein HJ, Schuster T, et al. Prevalence and topography of lymph node metastases in early esophageal and gastric cancer. Ann Surg, 2014, 259(1): 96-101.
8.	Tanaka T, Matono S, Mori N, et al. T1 squamous cell carcinoma of the esophagus: Long-term outcomes and prognostic factors after esophagectomy. Ann Surg Oncol, 2014, 21(3): 932-938.
9.	Dubecz A, Kern M, Solymosi N, et al. Predictors of lymph node metastasis in surgically resected T1 esophageal cancer. Ann Thorac Surg, 2015, 99(6): 1879-1885.
10.	Zhang H, Tang P, Miao X, et al. Does tumor size improve the accuracy of prognostic prediction in patients with esophageal squamous cell carcinoma after surgical resection? Oncotarget, 2016, 7(41): 66623-66634.
11.	Hsu WH, Hsu PK, Hsieh CC, et al. The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg, 2009, 13(11): 1913-1920.
12.	Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: An international study on the impact of extent of surgical resection. Ann Surg, 2008, 248(4): 549-556.
13.	Hsu PK, Chien LI, Wang LC, et al. Lymphovascular invasion and extracapsular invasion are risk factors for distant recurrence after preoperative chemoradiotherapy and oesophagectomy in patients with oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg, 2017, 51(6): 1188-1194.
14.	Kuge K, Murakami G, Mizobuchi S, et al. Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus. J Thorac Cardiovasc Surg, 2003, 125(6): 1343-1349.
15.	Mizutani M, Murakami G, Nawata S, et al. Anatomy of right recurrent nerve node: Why does early metastasis of esophageal cancer occur in it? Surg Radiol Anat, 2006, 28(4): 333-338.
16.	Bollschweiler E, Baldus SE, Schröder W, et al. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy, 2006, 38(2): 149-156.
17.	Endo M, Yoshino K, Kawano T, et al. Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis Esophagus, 2000, 13(2): 125-129.
18.	Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2010. Esophagus, 2017, 14(3): 189-214.
19.	Wang J, Zhu XN, Zhu LL, et al. Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma and precancerous lesions. World J Gastroenterol, 2018, 24(26): 2878-2885.
20.	Suzuki G, Yamazaki H, Aibe N, et al. Endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer: Choice of new approach. Radiat Oncol, 2018, 13(1): 246.
21.	Kawaguchi G, Sasamoto R, Abe E, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol, 2015, 10: 31.
22.	Ikeda A, Hoshi N, Yoshizaki T, et al. Endoscopic submucosal dissection (ESD) with additional therapy for superficial esophageal cancer with submucosal invasion. Intern Med, 2015, 54(22): 2803-2813.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, Mar-Apr 2016, 66(2): 115-132.
2. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. Merkow RP, Bilimoria KY, Keswani RN, et al. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst, 2014, 106(7): dju133.
4. Nentwich MF, von Loga K, Reeh M, et al. Depth of submucosal tumor infiltration and its relevance in lymphatic metastasis formation for T1b squamous cell and adenocarcinomas of the esophagus. J Gastrointest Surg, 2014, 18(2): 242-249.
5. Akutsu Y, Uesato M, Shuto K, et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: A retrospective analysis of 295 patients. Ann Surg, 2013, 257(6): 1032-1038.
6. Lee L, Ronellenfitsch U, Hofstetter WL, et al. Predicting lymph node metastases in early esophageal adenocarcinoma using a simple scoring system. J Am Coll Surg, 2013, 217(2): 191-199.
7. Gertler R, Stein HJ, Schuster T, et al. Prevalence and topography of lymph node metastases in early esophageal and gastric cancer. Ann Surg, 2014, 259(1): 96-101.
8. Tanaka T, Matono S, Mori N, et al. T1 squamous cell carcinoma of the esophagus: Long-term outcomes and prognostic factors after esophagectomy. Ann Surg Oncol, 2014, 21(3): 932-938.
9. Dubecz A, Kern M, Solymosi N, et al. Predictors of lymph node metastasis in surgically resected T1 esophageal cancer. Ann Thorac Surg, 2015, 99(6): 1879-1885.
10. Zhang H, Tang P, Miao X, et al. Does tumor size improve the accuracy of prognostic prediction in patients with esophageal squamous cell carcinoma after surgical resection? Oncotarget, 2016, 7(41): 66623-66634.
11. Hsu WH, Hsu PK, Hsieh CC, et al. The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg, 2009, 13(11): 1913-1920.
12. Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: An international study on the impact of extent of surgical resection. Ann Surg, 2008, 248(4): 549-556.
13. Hsu PK, Chien LI, Wang LC, et al. Lymphovascular invasion and extracapsular invasion are risk factors for distant recurrence after preoperative chemoradiotherapy and oesophagectomy in patients with oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg, 2017, 51(6): 1188-1194.
14. Kuge K, Murakami G, Mizobuchi S, et al. Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus. J Thorac Cardiovasc Surg, 2003, 125(6): 1343-1349.
15. Mizutani M, Murakami G, Nawata S, et al. Anatomy of right recurrent nerve node: Why does early metastasis of esophageal cancer occur in it? Surg Radiol Anat, 2006, 28(4): 333-338.
16. Bollschweiler E, Baldus SE, Schröder W, et al. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy, 2006, 38(2): 149-156.
17. Endo M, Yoshino K, Kawano T, et al. Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis Esophagus, 2000, 13(2): 125-129.
18. Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2010. Esophagus, 2017, 14(3): 189-214.
19. Wang J, Zhu XN, Zhu LL, et al. Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma and precancerous lesions. World J Gastroenterol, 2018, 24(26): 2878-2885.
20. Suzuki G, Yamazaki H, Aibe N, et al. Endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer: Choice of new approach. Radiat Oncol, 2018, 13(1): 246.
21. Kawaguchi G, Sasamoto R, Abe E, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol, 2015, 10: 31.
22. Ikeda A, Hoshi N, Yoshizaki T, et al. Endoscopic submucosal dissection (ESD) with additional therapy for superficial esophageal cancer with submucosal invasion. Intern Med, 2015, 54(22): 2803-2813.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of surgical management for esophageal squamous cell carcinoma in pathological stage T1b

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